Heart Failure

Topic Overview

What is heart failure?

Heart failure means that your heart muscle doesn't pump as much blood as your body
needs. Failure doesn't mean that your heart has stopped. It means that your heart
is not pumping as well as it should.

Because your heart cannot pump well, your body tries to make up for it. To do this:

Your body holds on to salt and water. This increases the amount of blood in your bloodstream.

Your body has an amazing ability to make up for heart failure. It may do such a good
job that you don't know you have a disease. But at some point, your heart and body
will no longer be able to keep up. Then fluid starts to build up in your body, and
you have symptoms like feeling weak and out of breath.

This fluid buildup is called congestion. It's why some doctors call the disease congestive
heart failure.

Heart failure usually gets worse over time. But treatment can slow the disease and
help you feel better and live longer.

What causes heart failure?

Anything that damages your heart or affects how well it pumps can lead to heart failure.
Common causes of heart failure are:

What are the symptoms?

Symptoms of heart failure start to happen when your heart cannot pump enough blood
to the rest of your body. In the early stages, you may:

Feel tired easily.

Be short of breath when you exert yourself.

Feel like your heart is pounding or racing (palpitations).

Feel weak or dizzy.

As heart failure gets worse, fluid starts to build up in your lungs and other parts
of your body. This may cause you to:

Feel short of breath even at rest.

Have swelling (edema), especially in your legs, ankles, and feet.

Gain weight. This may happen over just a day or two, or more slowly.

Cough or wheeze, especially when you lie down.

Feel bloated or sick to your stomach.

If your symptoms suddenly get worse, you will need emergency care.

How is heart failure diagnosed?

Your doctor may diagnose heart failure based on your symptoms and a physical exam.
But you will need tests to find the cause and type of heart failure so that you can
get the right treatment. These tests may include:

An echocardiogram can help show if you have heart failure, what type it is, and what
is causing it. Your doctor can also use it to see if your heart failure is getting
worse.

This test can measure how much blood your heart pumps to your body. This measurement
is called the ejection fraction. If your ejection fraction gets lower and you are having more symptoms, it means
that your heart failure is getting worse.

How is it treated?

Most people with heart failure need to take several medicines. Your doctor may prescribe
medicines to:

Help keep heart failure from getting worse. These drugs include ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers,
and vasodilators like hydralazine and a nitrate.

Reduce symptoms so you feel better. These drugs include diuretics (water pills) and digoxin.

Treat the cause of your heart failure.

It is very important to take your medicines exactly as your doctor tells you to. If
you don't, your heart failure could get worse.

Pacemaker or defibrillator

A pacemaker or a defibrillator (such as an ICD) may be an option for you if you have
a problem with your heart rhythm. A pacemaker can help your heart pump blood better.
A defibrillator can prevent a dangerous heart-rhythm problem.

Care at home

Lifestyle changes are an important part of treatment. They can help slow down heart
failure. They may also help control other diseases that make heart failure worse,
such as high blood pressure, diabetes, and coronary artery disease.

The best steps you can take are to:

Eat less sodium. Sodium causes your body to hold on to water and may make symptoms worse. Your doctor
may also ask you to limit how much fluid you drink.

Get regular exercise. Your doctor can tell you what level of exercise is safe for you, how to check your
pulse, and how to know if you are doing too much.

Take rest breaks during the day.

Lose weight if you are overweight. Even a few pounds can make a difference.

Ask your doctor if cardiac rehab is right for you. Rehab can give you education and support that help you learn self-care
and build new healthy habits, such as exercise and healthy eating.

To stay as healthy as possible, work closely with your doctor. Have all your tests,
and go to all your appointments. It is also important to:

Talk to your doctor before you take any new medicine, including nonprescription and
prescription drugs, vitamins, and herbs. Some of them may make your heart failure
worse.

Keep track of your symptoms. Weigh yourself at the same time every day, and write
down your weight. Call your doctor if you have a sudden weight gain, a change in your
ability to exercise, or any sudden change in your symptoms.

What can you expect if you have heart failure?

Medicines and lifestyle changes can slow or even reverse heart failure for some people.
But heart failure often gets worse over time.

Early on, your symptoms may not be too bad. As heart failure gets worse, you may need
to limit your activities. Treatment can often help reduce symptoms, but it usually
doesn't get rid of them.

Heart failure can also lead to other health problems. These may include:

Your doctor may be able to give you medicine or other treatment to prevent or treat
these problems.

Heart failure can get worse suddenly. If this happens, you will need emergency care.
To prevent sudden heart failure, you need to avoid things that can trigger it. These include eating too much salt,
missing a dose of your medicine, and exercising too hard.

Knowing that your health may get worse can be hard. It is normal to sometimes feel
sad or hopeless. But if these feelings last, talk to your doctor. Antidepressant medicines,
counseling, or both may help you cope.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health
problems.

Certain triggers, such as too much sodium or not taking medicines the right way, may suddenly make
heart failure worse. This can sometimes cause deadly problems such as pulmonary edema or cardiogenic shock.

Symptoms

At first you may not have any symptoms from heart failure. For a while, your heart
and body can make up for heart failure. For example, your heart can pump faster and
pump more blood with each beat. This is called compensation.

But as your heart has more trouble pumping enough blood to your body, you will likely
have symptoms. These symptoms may get worse or change if your heart failure gets worse.

Symptoms of heart failure start to happen when your heart can't pump enough blood
to the rest of your body. In the early stages, you may:

As heart failure gets worse, fluid starts to build up in your lungs and other parts
of your body. This may cause you to:

Feel short of breath even at rest.

Have swelling (edema), especially in your legs, ankles, and feet.

Gain weight. This may happen over just a day or two, or more slowly.

Cough or wheeze, especially when you lie down.

Feel bloated or sick to your stomach.

How doctors talk about heart failure

There is more than one type of heart failure. Each type is based on what problem in the heart is causing it to not pump as much
blood as normal.

Heart failure is grouped—or classified—according to symptoms. Your treatment is based partly on what class of symptoms you
have.

There's also another way to define heart failure. It's based on the stages you might go through as your heart failure gets worse. Your doctor also may make
treatment choices based on your stage of heart failure.

Symptoms of sudden heart failure

Sometimes your symptoms may get worse very quickly. This is called sudden heart failure.
It causes fluid to build up in your lungs, causing congestion. (This is why the problem
is often called congestive heart failure.) Symptoms may include:

More information

What Increases Your Risk

Your risk for having heart failure is higher if you have certain risk factors. A risk
factor is anything that increases your chance of having a particular problem.

Heart failure is usually caused by another health problem, often coronary artery disease or high blood pressure. So anything that increases your risk for one of those problems
also increases your risk for heart failure.

Risk factors for coronary artery disease and heart attack include smoking, having high cholesterol or diabetes, and having a family history
of heart disease.

Risk factors for high blood pressure include being overweight, being inactive, and having a family history of high blood
pressure.

Risk factors for heart valve disease include older age and an infection of the valves.

As part of your ongoing treatment, your doctor will also try to prevent or treat problems—such
as fever, arrhythmia, and anemia—that can lead to sudden heart failure. Treatment may include:

Getting vaccines. Your doctor may want you to get vaccines against pneumonia and flu. These vaccines can keep you from getting infections that could put you in the hospital.

Checking your weight. Your doctor will probably give you guidelines for watching fluid buildup and tell
you how much weight gain is too much.

Getting devices to fix heart rhythm problems. In some cases, your doctor may recommend a biventricular pacemaker that can help your heart pump blood better. This is also called cardiac resynchronization
therapy (CRT). Or you may have an implantable cardioverter-defibrillator (ICD) to stop a deadly rhythm. Some people get a pacemaker that is combined with an ICD.

Cardiac rehabilitation, a supervised program that uses exercise, education, and support
to help people live well with heart failure. For more information, see the topic Cardiac Rehabilitation.

Sometimes heart failure can be fixed if another problem can be corrected, such as
by treating hyperthyroidism.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different
from care to cure your illness. Its goal is to improve your quality of life—not just
in your body but also in your mind and spirit.

You can have this care along with treatment to cure your illness. You can also have
it if treatment to cure your illness no longer seems like a good choice.

Palliative care providers will work to help control pain or side effects. They may
help you decide what treatment you want or don't want. And they can help your loved
ones understand how to support you.

End-of-life care

Heart failure tends to get worse over time. So you need to decide what kind of care
you want at the end of your life.

It can be hard to have talks with your doctor and family about the end of your life.
But making these decisions now may bring you and your family peace of mind. Your family
won't have to wonder what you want. And you can spend your time focusing on your relationships.

You will need to decide if you want life-support measures if your health gets very
bad. An advance directive is a legal document that tells doctors how to care for you at the end of your life.
This care includes electronic devices that are used for heart failure, such as pacemakers.
You also can say where you want to have care. And you can name someone who can make
sure your wishes are followed.

Get regular exercise. Try to do activities that raise your heart rate. Aim for at least 2½ hours of moderate exercise a week.footnote 1

Stay at a healthy weight. Lose weight if you need to.

Manage other health problems that can raise your risk of heart disease and heart failure. These include high blood
pressure, high cholesterol, and diabetes. You can use heart-healthy lifestyle changes
along with medicines to manage these conditions.

Living With Heart Failure

You can feel better when you have heart failure by taking your medicines as directed,
having a healthy lifestyle, and avoiding things that make heart failure worse. Know
what things you can do every day to stay healthy, what symptoms to watch for, and
when to call a doctor.

Ask your doctor if cardiac rehab is right for you. Rehab can give you education and support that help you learn self-care
and build new healthy habits, such as exercise and healthy eating.

Having a healthy lifestyle

Limit sodium. Your doctor might recommend that you limit sodium to less than 2,000 mg a day. Limiting
sodium can help you feel better and prevent sudden heart failure. Fluid may build
up in your lungs—making it harder for you to breathe—and in your feet, ankles, legs,
and belly.

Exercise regularly. If you aren't already active, your doctor may want you to start exercising. Do not
start exercising until you have talked with your doctor to make an exercise program
that is safe for you. You could do it in a cardiac rehabilitation program or on your own.

Check your weight at the same time every day. Checking your weight helps you keep track of your symptoms. Sudden weight gain may
mean that fluid is building up in your body because your heart failure is getting
worse.

Avoiding things that make heart failure worse

Treating your sleep problems

One Man's Story:

Pete, 70

"I was having a lot of trouble getting enough sleep. I was snoring so bad that my
wife was sleeping in another room. I'd wake up 7 times a night. Sometimes I'd wake
up gasping for breath. The next day I'd be so tired that I'd fall asleep while doing
my woodworking in the garage. And I was really fuzzy-headed. I couldn't remember anything.

"I thought it might be my heart failure. So I decided to talk to my doctor about it,
and he suggested a sleep study. I found out that I have sleep apnea. I haven't been
getting enough oxygen because of it. He put me on a CPAP machine at night. I've used
it for the past 4 months.

"It took a little time to get used to sleeping with a mask. But I'm sleeping much
better. Now if I wake up, it's only once, and I go right back to sleep. I feel so
much better during the day."— Pete

This story is based on information gathered from many people living with heart failure.

Many people with heart failure have trouble sleeping. Your doctor may be able to find
out what is causing your sleep problems and help you get a good night's sleep.

Other things you can do to take care of yourself

Get help for depression and anxiety if you have them. Heart failure can be hard on your emotions. Many people with heart
failure feel depressed or anxious. For more information on how to feel better, see
Coping With Your Feelings.

Help for caregivers

It can be rewarding to help a loved one with heart failure. But it's also a lot of
work. And it can be hard emotionally.

If you are taking care of a loved one, make sure that you also take care of yourself.
This can mean taking breaks by getting help from family or friends. You also may be
able to use respite care. These services provide someone who will stay with your loved
one while you get out of the house for a few hours.

More information

Coping With Your Feelings

Heart failure brings big changes to your life. You may struggle with sadness and worry.
You may wonder if you'll still be able to enjoy your life. Coping with your feelings
and seeking help when you need it can help you live better with heart failure.

Depression and anxiety

Heart failure can be hard on your emotions. You may feel depressed that you can't
do some of the things you used to do. You may worry about your future. And symptoms
of heart failure, such as shortness of breath, can make this anxiety worse.

These feelings are common. Talk to your doctor if you have symptoms of depression or are worried a lot. Depression and anxiety can be treated with counseling and medicine.

You also can help yourself feel better by changing your "self-talk." Those are the
things you tell yourself about how you're coping. Negative thoughts can make you feel
bad. Changing the way you think can change the way you feel.

Stress

The challenges of living with heart failure can increase your stress. And stress can
make living with heart failure even harder. Stress also can disturb your sleep and
make depression and anxiety worse. Explore ways to relax and manage stress to help
your body, mind, and spirit.

Getting support

Emotional support from friends and family can help you cope with the struggles of
heart failure. You might want to think about joining a heart failure support group.
Ask your doctor about the types of support that are available where you live.

Cardiac rehab programs can offer support for you and your family. Ask your doctor
if rehab is right for you.

Meeting other people with the same problems can help you know you're not alone. If
you're shy or aren't a joiner, you can look at an online support group. Even though
people online aren't talking face-to-face, they're sharing their feelings and creating
a community.

Medications

You probably will need to take several medicines to treat heart failure, even if you
don't have symptoms yet.

Medicines don't cure heart failure. But they can help your heart work better and improve
symptoms.

Other Treatment

Pacemakers

Cardiac resynchronization therapy (CRT) uses a biventricular pacemaker, which makes the heart's lower chambers (ventricles)
pump together. This can help your heart pump blood better. This type of pacemaker
can help you feel better so you can be more active. It also can help keep you out
of the hospital and help you live longer.

A pacemaker may be used alone or along with an implantable cardioverter-defibrillator
(ICD) for heart failure.

Implantable defibrillators (ICDs)

Implantable cardioverter-defibrillators (ICDs) can prevent sudden death from an abnormal heart rhythm and may help you live
longer. An ICD checks the heart for very fast and deadly heart rhythms. If the heart
goes into one of these rhythms, the ICD shocks it to stop the deadly rhythm and returns
the heart to a normal rhythm.

Ventricular assist devices (VADs)

Ventricular assist devices (VADs), also known as heart pumps, may be placed into the chest to help the heart pump more
blood. VADs can keep people alive until a donor heart is available for transplant. In some cases,
VADs may also be used as an alternative to heart transplant for long-term treatment.
VADs are used in people who have severe heart failure.

Intra-aortic balloon pump

Supplements

Talk to your doctor before you take any over-the-counter medicine or supplement. They
are used along with medical treatments for heart failure, not instead of treatment.

You may hear about supplements, vitamins, or hormones that might improve heart failure
symptoms.

Fish oil (omega-3 fatty acid) supplements have been shown to help some heart failure
patients. In some studies, fish oil supplements, taken along with other heart failure
medicines, helped people stay out of the hospital and live longer.footnote 2

No other supplement, vitamin, or hormone has been shown definitely to relieve heart
failure or help you live longer.

Examples include coenzyme Q10 and hawthorn.

Only some of the studies of coenzyme Q10 showed that it helps heart failure symptoms.footnote 3

Hawthorn is an herb that is sometimes used in Europe and Asia to try to increase blood
flow to the heart.

Riegel B, et al. (2009). State of the science. Promoting self-care in patients with
heart failure. A scientific statement from the American Heart Association. Circulation,
120(12): 1141–1163.

Rosendorff C, et al. (2015). Treatment of hypertension in patients with coronary artery
disease: A scientific statement from the American Heart Association, American College
of Cardiology, and American Society of Hypertension. Circulation, 131(19): e435–e470.
DOI: 10.1161/CIR.0000000000000207. Accessed March 31, 2015.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy
for patients with coronary and other atherosclerotic vascular disease: 2011 update:
A guideline from the American Heart Association and American College of Cardiology
Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

Somers VK, et al. (2008). Sleep apnea and cardiovascular disease: An American Heart
Association/American College of Cardiology Foundation Scientific Statement from the
American Heart Association Council for High Blood Pressure Research Professional Education
Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular
Nursing in collaboration with the National Heart, Lung, and Blood Institute National
Center on Sleep Disorders Research (National Institutes of Health). Circulation, 118(10):
1080–1111.

Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure:
A report of the American College of Cardiology Foundation/American Heart Association
Task Force on Practice Guidelines. Journal of the American College of Cardiology,
62(16): e147–e239.

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